Provider Demographics
NPI:1417024738
Name:GERIATRIC SERVICES OF NORTHERN COLORADO LLC
Entity Type:Organization
Organization Name:GERIATRIC SERVICES OF NORTHERN COLORADO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMRA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MEURER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:970-388-5588
Mailing Address - Street 1:1137 WYNDHAM HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7201
Mailing Address - Country:US
Mailing Address - Phone:970-388-5588
Mailing Address - Fax:
Practice Address - Street 1:1137 WYNDHAM HILL RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7201
Practice Address - Country:US
Practice Address - Phone:970-388-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0002096-NP363LF0000X
CO76875310400000X, 311ZA0620X, 313M00000X, 314000000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20671725Medicaid
COC807607Medicare PIN
COS31345Medicare UPIN